Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infection caused by a novel Bunyavirus. Analysis on the dynamic changes of clinical, laboratory, and immunological abnormalities associated with SFTS in a concurrent study is lacking. Thirty-three SFTS patients were admitted to Jiangsu People's Hospital, Nanjing, China, and diagnosis was made based on the clinical symptoms and positive viral RNA detected by RT-PCR. Four patients deceased and twenty-nine survived. Blood samples were collected every other day between Day 5 and Day 15 from the onset of fever. Samples from healthy volunteers were used as normal controls. Peak viral RNA load, serum enzymes, IL-6, and IL-10 were significantly higher in deceased patients compared to survivors. Viral load, serum enzymes, and cytokines declined in survivors within 2 weeks from onset of fever. CD69+ T cells were elevated early after infection while HLA-DR+ and CTLA4+ T cells were elevated during the recovery phase of those who survived. High level SFTSV viral load was concurrently observed with reduced PLT, elevated serum enzymes, elevated pro-inflammatory and anti-inflammatory cytokines, and activation of CD69+ T cells. The degree and pattern of changes in these parameters may indicate the clinical outcome in SFTSV-infected patients.

Conclusion: Coronary-pulmonary artery fistula in adults was found more often than in previous studies. CAF commonly originates from LCA or both LCA and RCA in adults. DSCT is a robust tool for investigating the origin, course and drainage site of CAF and coexistent abnormalities. Advances in knowledge: A large adult patient cohort who underwent DSCT angiography was reviewed to assess CAFs. Coronary-pulmonary artery fistula in adults was found more often than in previous studies. CAF was observed to originate from the LCA or both coronary arteries in adults. DSCT could clearly depict the fistula origin, course, drainage site and coexisting abnormalities. Conventional angiography results, treatments and followup DSCT images were analysed.Coronary artery fistulas (CAFs) are anomalous connections of the coronary arteries. The phenomenon was first described in 1865 by Krause. 1 CAF is considered as a major coronary anomaly by Ogden's classification.2 Most CAFs are congenital. CAFs have an estimated prevalence of 0.002% in the general population; however, they are present in 0.05-0.25% of patients who undergo coronary angiography.3-5 The traditional diagnosis tool for CAFs is conventional angiography. With the advent of 64-slice multidetector CT in chest and cardiac imaging, the number of incidentally found CAFs has been increasing. The advanced electrocardiogram (ECG)-gated technique of dual-source CT (DSCT) could provide high diagnostic accuracy for the assessment of coronary artery disease.According to prior studies, CAF arises from the right coronary artery (RCA) in approximately 50% of patients. [6][7][8] In particular, 70% of the CAFs in children (mean age, 2.9 years) originated from the RCA. 9 In this study, we focused on adult patients. A large cohort of adult patients who underwent DSCT angiography was reviewed to assess CAFs. The CAFs and coexisting abnormalities were analysed. METHODS AND MATERIALS PatientsA total of 17,548 patients who were suspected of having coronary artery disease underwent contrast-enhanced CT angiography (CCTA) from January 2008 to October 2013 in Peking Union Medical College Hospital, Beijing, China. The CCTA reports and images were retrospectively reviewed. Four experienced radiologists reviewed the axial, maximum intensity projection and volume rendering technique images of all 17,548 patients through the picture archiving and communication system. All the images were reviewed only once because of the large amount of work.

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ADC histogram analysis may assist in assessing the WHO pathological classification and Masaoka clinical stages of thymic epithelial tumours. Advances in knowledge: 1. ADC histogram analysis could help to assess WHO pathological classification of thymic epithelial tumours. 2. ADC histogram analysis could help to evaluate Masaoka clinical stages of thymic epithelial tumours. 3. ADC might be a promising imaging biomarker for assessing and characterizing thymic epithelial tumours.

Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.

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ObjectiveTo assess the performance of a whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating thymic carcinoma from lymphoma, and compare it with that of a commonly used hot-spot region-of-interest (ROI)-based ADC measurement.Materials and MethodsDiffusion weighted imaging data of 15 patients with thymic carcinoma and 13 patients with lymphoma were retrospectively collected and processed with a mono-exponential model. ADC measurements were performed by using a histogram-based and hot-spot-ROI-based approach. In the histogram-based approach, the following parameters were generated: mean ADC (ADCmean), median ADC (ADCmedian), 10th and 90th percentile of ADC (ADC10 and ADC90), kurtosis, and skewness. The difference in ADCs between thymic carcinoma and lymphoma was compared using a t test. Receiver operating characteristic analyses were conducted to determine and compare the differentiating performance of ADCs.ResultsLymphoma demonstrated significantly lower ADCmean, ADCmedian, ADC10, ADC90, and hot-spot-ROI-based mean ADC than those found in thymic carcinoma (all p values < 0.05). There were no differences found in the kurtosis (p = 0.412) and skewness (p = 0.273). The ADC10 demonstrated optimal differentiating performance (cut-off value, 0.403 × 10−3 mm2/s; area under the receiver operating characteristic curve [AUC], 0.977; sensitivity, 92.3%; specificity, 93.3%), followed by the ADCmean, ADCmedian, ADC90, and hot-spot-ROI-based mean ADC. The AUC of ADC10 was significantly higher than that of the hot spot ROI based ADC (0.977 vs. 0.797, p = 0.036).ConclusionCompared with the commonly used hot spot ROI based ADC measurement, a histogram analysis of ADC maps can improve the differentiating performance between thymic carcinoma and lymphoma.

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